Transcript Diapositiva 1 - metcardio.org

BENEFITS OF CLOPIDOGREL IN PATIENTS
UNDERGOING CORONARY STENTING
SIGNIFICANTLY DEPEND ON LOADING
DOSE: EVIDENCE FROM A SYSTEMATIC
REVIEW AND META-REGRESSION
G. BIONDI-ZOCCAI1, C. MORETTI1, P. AGOSTONI2,
M. VALGIMIGLI3, A. ABBATE4, D. ANGIOLILLO5,
G. SANGIORGI6, G. TREVI1 AND I. SHEIBAN1
1University of Turin, Turin, Italy; 2AZ Middelheim, Antwerp, Belgium;
3University of Ferrara, Ferrara, Italy; 4Virginia Commonwealth University, Virginia, USA;
5University of Florida, Jacksonville, Florida, USA; 6Emo Centro Cuore Columbus, Milano, Italy
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BACKGROUND
• Clopidogrel is an established
alternative to ticlopidine in addition to
aspirin after coronary stenting
because of its safety, but its optimal
initial dosing is unclear
• Moreover, there is ongoing
uncertainty on the comparison of
clopidogrel vs ticlopidine in terms of
antithrombotic efficacy
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OBJECTIVES
• To perform a systematic review of
randomized clinical trials (RCT)
comparing clopidogrel vs ticlopidine
• To pool major outcomes with metaregression techniques focusing on
clopidogrel front-loading
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METHODS
• PubMed was searched for pertinent
studies (updated August 2006)
• Random-effect odds ratios (OR) with 95%
confidence intervals were computed for
death or non-fatal myocardial infarction
• Weighted least squares random-effect
meta-regression was performed to explore
the impact of loading vs non-loading
clopidogrel scheme
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RESULTS
• We retrieved 7 trials (3382 patients, average
follow-up 7 months)
• In 5 studies both clopidogrel and ticlopidine were
started with a loading dose, in 1 trial clopidogrel
was administered without loading, and in 1 trial
clopidogrel could be administered with or without
loading
• Overall analysis (p for heterogeneity=0.02)
showed similar results for clopidogrel or
ticlopidine (OR=0.90 [0.44-1.84], p=0.77)
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RESULTS
• In studies administering clopidogrel with loading,
this treatment was however significantly better
than ticlopidine (OR=0.60 [0.36-0.99], p=0.05)
• This significant interaction between clopidogrel
loading and its superiority in comparison to
ticlopidine, was also formally confirmed by meta-
regression (beta=-0.64, p=0.012)
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REVIEW PROFILE
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INCLUDED STUDIES
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RISK OF DEATH OR MI
AT LONG-TERM FOLLOW-UP
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META-REGRESSION
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CONCLUSIONS
• The present updated systematic review
and meta-regression of clinical trials
comparing clopidogrel vs ticlopidine in
patients undergoing coronary stenting
shows that clopidogrel is superior to
ticlopidine if an initial loading is
administered
• Conversely the available data suggest that
clopidogrel might be inferior to ticlopidine if
administered without loading
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